Provider Demographics
NPI:1144232372
Name:ROSS, JENNIFER G (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 GEARY BLVD
Mailing Address - Street 2:316
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3455
Mailing Address - Country:US
Mailing Address - Phone:415-346-3081
Mailing Address - Fax:415-346-3757
Practice Address - Street 1:2186 GEARY BLVD
Practice Address - Street 2:316
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3455
Practice Address - Country:US
Practice Address - Phone:415-346-3081
Practice Address - Fax:415-346-3757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71450174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G714500Medicaid
CA00G714500Medicare ID - Type Unspecified
CA00G714500Medicaid